Kune zvidimbu zvinyorwa zvemasayenzi vanachiremba vanotarisa kuitira kuti vaongorore kenza yepancreatic . Kuenzanisa miedzo kunogona kusanganisira chirongwa chepamuviri CT scan, endoscopic ultrasound, MRI, kana ERCP. Kuyera ropa kunogona kutarisa zvinokonzera jaundice pamwe nekutura zviratidzo. Uye nhau yezvechiremba inotarisa pamatambudziko, pamwe chete nekuongorora mumuviri, inokosha.
Bhiopsy inogona kana kuti isingadi, zvichienderana nezvimwe zvakawanikwa. Mushure mekunge uongororwa, kuongorora kunoitwa kuti uone zvirwere zvakakodzera zvakanyanya kune chirwere chacho.
Munhu wese anofanira kunge achiziva zviratidzo zvinogona kuchenesa uye zviratidzo zvekenza yepancreatic , saka vanogona kutsvaka kurapwa kwechiremba nekukurumidza.
Labs uye Miedzo
Iko kuongororwa kwekwanisika yemukenza wepancreatic inowanzotanga nekunyatsocherechedza uye kuongorora muviri. Chiremba wako achakubvunza mibvunzo pamusoro peipi njodzi ipi zvayo inogona kuve nayo, kusanganisira nhoroondo yemhuri yechirwere ichi, uye ichabvunza nezve zviratidzo zvako. Iye achazoita kuongorora kwepanyama achitarisa ganda rako nemaziso nokuda kweuchapupu hwejerice ; kuongorora mimba yako kuti zvinogona kuitika kana kuwedzerwa kwechiropa chako, kana humwe humwe uchapupu hwe ascites (kuvaka-up ye-fluid mudumbu), uye kuongorora zvinyorwa zvako kuti uone kana iwe uine uremu.
Kuongororwa kweropa kusagadzikana nekenza yepancreatic hazvina kunyatsojeka asi dzimwe nguva kunobatsira pakugadziriswa kana ichibatanidzwa nekuongorora mifananidzo.
Miedzo inogona kusanganisira:
- Chiropa work test, iyo dzimwe nguva inowedzera
- Aine ropa rakazara (CBC), achitarisa imwe yakakwirira yeplatelet (thrombocytosis) kunyanya
- Kuongorora kwebilirubin: Kune marudzi akasiyana e-bilirubin, uye zvichienderana nemhando chaiyo yakaongororwa, vanachiremba vanogona kuwana zvinyorwa sekubva kune jerice ipi zvayo yaunayo. Nechibvumirano chekudzivirira chirwere (nemhaka yechipfupa chepascreatic chinosungira pane yakazara bile duct), kune zvikwiriso mune zvose zviri zviviri uye zvinokwana bilirubin.
Ropa rega shuga rinowanzokwidziridzwa, sezvo vanenge 80 muzana yevanhu vane kenza yepancreatic vachaita kuti insulin isakanganise kana chirwere cheshuga. Inenge hafu yevanhu vane mapapiro mu serum amylase uye serum lipase mumatangiro epakutanga kwechirwere, asi zvishoma kudarika mune zvirwere zvakanyanya.
Tumor Markers
Kumhanyirira mapepa mapuroteni akavanzwa nemasero emakenza uye anogona kuonekwa kuburikidza neropa rekuongorora. Chimwe chezvikwangwani, carcinoembryonic antigen (CEA), yakasimudzirwa munenge hafu yevanhu vakaonekwa kuti vane chirwere asiwo yakasimudzirwa mune dzimwe mhando zhinji dzemamiriro ezvinhu zvakare. CA CA 19-9 inogona kuongororwa, asi sezvo iyo isingawanzosimudzirwa uye inokura mazinga inogonawo kuratidza mamwe mamiriro ezvehutano, izvi hazvibatsiri pakuita kuongororwa kwekenza yepancreatic. Ichi chigumisiro, zvisinei, chinobatsira pakusarudza kana chirwere chepakcreatic chinogona kubviswa chirwere, nekutevera nzira yekurapa.
Neuroendocrine Tumor Blood Test
Zvimwe kuongororwa kweropa zvinogona kubatsirawo pakuongorora rudzi rushoma rwemakondakitiri epancreatic anonzi seuroretocrine tumor. Kusiyana nemakumbo akawanda epancreatic, ayo anoumbwa nemasero anogadzira masimba enzymes, maronda aya anosanganisira masero endocrine anoita mahomoni akaita se insulin, glucagon, uye somatostatin.
Kuyera mazinga emahomoni aya, pamwe nekuita zvimwe zvidzidzo zveropa, zvinogona kubatsira pakutsvaga matumire aya.
Imaging
Kufananidza miedzo inowanzo ndiyo nzira yekutanga yekusimbisa kana kuramba kuvapo kwemazana mupascreas. Zvimwe zvinogona kusanganisira:
CT Scan
Computerized tomography (CT) inoshandisa X-rays kuti iite chikamu chepakati chemuviri wemuviri uye inowanzotarisirwa kuongororwa. Kana chiremba achifungira kenza yepancreatic chaiyo, chirongwa chaiye che CT scan chinonzi multiphase helical CT scan kana pancreatic protocol CT scan inowanzokurudzirwa.
A CT scan inogona kubatsira zvose pakuratidzika kwechirwere (kutarisa ukuru kwayo uye nzvimbo munzvimbo dzepascreas) uye kutsvaga chero uchapupu hwekupararira kune lymph nodes kana dzimwe nzvimbo.
CT inogona kuva yakakosha kudarika endoscopic ultrasound pakusarudza kana kenza yakapararira kune yakanyanya mesenteric arteri (inokosha pakusarudza kurapwa).
Endoscopic Ultrasound (EUS)
Ultrasound inoshandisa mazaya akajeka kuti aumbe mufananidzo wemuviri wemuviri. Chirwere chekare (transcutaneous) ultrasound hachiwanzoitwa kana chiremba anokonzera kenza yepancreatic, sezvakaitwa mumatumbo gasi zvinogona kuita kuonekwa kwepascreas zvakaoma. Asi zvinogona kubatsira kana uchitarisa mamwe matambudziko emimba.
An endoscopic ultrasound inogona kuva nzira inokosha pakuita kuti uongororwe. Yakagadzirwa kuburikidza ne-endoscopy, iyo inogadziriswa inogadziriswa ine probe ye ultrasound pakuguma kwayo inoiswa mumuromo uye yakasungirirwa pasi mudumbu kana mudiki mudumbu, kuitira kuti scan iite kubva mukati. Sezvo nzvimbo idzi dziri pedo nepascreas, muedzo unobvumira vanachiremba kuti vaone kutarisa kwakanaka kwechirongwa.
Nekushandiswa kwemishonga (conscious sedation), vanhu vanowanzotsungirira nzira iyo zvakanaka. Muedzo wacho unogona kuva wakarurama kupfuura CT kuti uongorore uwandu uye huwandu hwemarara asi hazvina kunaka pakutsvaga kupararira kwakakura kwechirwere (metastases) kana kuti kuronga kana tumarara inosanganisira midzi yeropa.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (ERCP) chiratidzo chinosanganisira endoscopy pamwe ne-X-rays kuitira kuti tifungidzire kuti ducts. ERCP inogona kuedza kuwana kenza yepancreatic asi haisi yakarurama pakusiyanisa chirwere ichi kubva kune dzimwe matambudziko, zvakadai sepancreatitis. Izvo zvakare nzira inopesana yakaipa maererano nemishumo iri pamusoro.
MRI
Magnetic resonance imaging (MRI) inoshandisa magetsi panzvimbo ye X-rays kuti igadzire mufananidzo wezvivako zvemukati. MRI inoshandiswa nguva shomanana kupfuura CT nekenza yepancreatic asi inogona kushandiswa mune mamwe mamiriro ezvinhu. Sezvo neCCT, kune mhando dzakasiyana dzeMRI, kusanganisira MR cholangiopancreatography (MRCP). Sezvo isina kuongororwa zvakanyanya sekuedza kunoitwa, inoshandiswa kunyanya kune vanhu avo vanoziva kuti havazivi zvakajeka zvichienderana nezvimwe zvidzidzo, kana kana munhu ane zvigaro zvemavara akasiyana-siyana anoshandiswa kuTCT.
Octreoscan
Muedzo unonzi octreoscan kana somatostatin receptor scintigraphy (SRC) inogona kuitika kana chirwere chinonzi neuroendocrine chepancreas chinenge chafungidzirwa. Mune octreoscan, puroteni yakasvibiswa (inonzi tracer) inojowa muvhein. Kana chirwere chinonzi neuroendocrine chiripo, muchengeti achasunga kumasero ari mumarara. Maawa mashomanana gare gare, kuongorora (scintigraphy) kunoitwa iyo inotora miviri ipi inenge ichitumirwa (neuroendocrine tumorumusi ichapenya, kana iripo).
PET Scan
PET inoongorora, inowanzobatanidzwa neCCT (PET / CT), inogona kuitika dzimwe nguva, asi inoshandiswa kakawanda nekenza yepancreatic kupfuura kune dzimwe kenza. Muchiedzwa ichi, zvishoma zveshuga zvinokonzerwa nehutachiona zvinoshandiswa mukati mevini uye shanduro inoitwa mushure mekunge shuga yava nenguva yekugadziriswa nemasero. Kukura masero masero, akadai sekenza masero, "achasimudza," kusiyana nemamwe masero akare kana kuti mavara mashoma.
Biopsy
Muenzaniso wezvinyama (a biopsy) dzimwe nguva zvinoda kusimbisa kuongororwa, uyewo kutarisa ma molecular maitiro echiremera.
Nheyo yakanaka yenzuchi (iyo nzira iyo ine nheyo ine tsvina inotungamirirwa kuburikidza neganda mumimba uye kupinda pancreas kuti ibudise muenzaniso wezvisikwa) inowanzoitwa uchishandisa mazano pamwe ne ultrasound kana CT. Pane kumwe kunetseka kuti rudzi urwu rwebiopsy rungagona "kudyara" chirwere, kana kukonzera kupararira kwekenza kune imwe nharaunda iyo nheyo inotangwa. Hazvizivikanwi kuti kudyara kunowanikwa kakawanda sei, asi maererano nekuongorora kwe 2017, nhamba yezvinyorwa zvekugadzira mbeu nekuda kwekupedzisira kwe-ultrasound-yakatungamirirwa zvakanaka nenyuchi chinoda kuwedzera nokukurumidza.
Sezvo zviopsies zviri kuitwa zvikurukuru kuona kana chirwere chinogona kuitwa (kurapa chete kunovandudza kurarama kwemazuva mazhinji), ichi chinhu chakakosha chakutaura pamusoro nachiremba wako.
Sezvo imwe nzira inoshandiswa, laparoscopy inogona kushandiswa, kunyanya kana bundu rinogona kubviswa (resectable). Mune laparoscopy, zvinyorwa zvishoma zvishoma zvinoshandiswa mudumbu uye chidimbu chiduku chinowanikwa kuti chiite biopsy. Kubva, panenge makumi maviri kubva muzana kubva panguva iyo, vanhu vanowanikwa vane chirwere chisina kukwana mushure mekuvhiyiwa yatotanga kuve nekenza yepancreatic, vamwe vanachiremba vanokurudzira kuita ichi kuedza kune ani zvake achazovhiyiwa (kurega kuvhiyiwa pasina kukodzera).
Kusiyanisa Kuongorora
Pane huwandu hwemamiriro ezvinhu anogona kuenzanisa zviratidzo zvekenza yepancreatic kana kuita kuti zvimwe zvakawanikwa kuongororwa ropa nekufungidzira. Vanachiremba vachashanda kuti vatonge kunze kwekutevera vasati vatanga kuziva:
- Bhara duct rakagadziriswa: A bile duct rakagadziriswa isinganzwisisiki kuderedza bate duct. Inogona kukonzerwa nemashizha kana chirurudzo kuti ibvise, asi inogona kukonzerwa nekenza yepancreatic.
- Yakanaka kana isingagumi pancreatitis: Pancreatitis , kuputika kwepancreas, kunogona kukonzera zviratidzo zvakafanana, asi hazviiti kuti kuwanda. Munharaunda inenge 1 mu20 vanhu, pancreatitis yakawanda iripo panguva yekuongororwa kwekenza yepancreatic.
- Bira duct matombo: Matombo mu bile duct anogona kukonzera zviratidzo zvebstructive jaundice uye inogona kuonekwa pa ultrasound. Kufanana neB bile duct strictures, zvisinei, vangave varipo pamwe nekenza yepancreatic.
- Ampullary carcinoma
- Gallbladder kenza : Gallbladder kenza inogona kuoneka yakafanana zvikuru nekenza yepancreatic, asi inogona kusiyaniswa neTCT kana MRI.
- Gallstones (cholelithiasis)
- Gastric kana duodenal ulcers
- Abdominal aortic aneurysm
- Pancreatic lymphoma
- Gastric lymphoma
- Chirwere cheropa
- Bhiza rekenza yemarara
Staging
Kusarudza nzvimbo yekenza yepancreatic inonyanya kukosha kana zvasvika pakusarudza kana kenza inogona kubviswa chirwere kana kwete. Kana kushambadzira kusina kururama, kunogona kutungamirira pakuvhiyiwa pasina. Kuderedza kunogonawo kubatsira mukufungidzira kusarudzwa kwechirwere.
TNM Staging
Vanachiremba vanoshandisa chirongwa chinonzi TNM staging kuti vaone danho remarara. Izvi zvinogona kuvhiringidza zvakanyanya pakutanga asi zviri nyore kwazvo kunzwisisa kana iwe uchiziva kuti zvinyorwa izvi zvinorevei.
T inomirira tumor. Chirwere chinopiwa nhamba kubva kuT1 kusvika kuT4 inobva paukuru hwechirwere, pamwe chete nezvimwe zvivako chirwere chinogona kunge chakapinda.
| T1 | Tumhino yakabatanidzwa kune pancreas uye isiri pasi pe2 cm |
| T2 | Tumhino yakagadzirirwa kune pancreas uye kupfuura 2 cm |
| T3 | Tumhanyi inopfuurira pane pancreas (kusvika ku duodenum, bile duct, portal kana mesenteric vein), asi haisanganisi mhepo inonzi celiac kana kuti mastory yemententeric yakakwirira |
| T4 | Kumhanyira kunosanganisira mutsetse weieriac kana kuti mametestery anopfuura maestent |
N inomirira lymph nodes. N0 zvinoreva kuti chirwere chisina kupararira kune chero nhengo dzemaitiro. N1 zvinoreva kuti tumarara yakapararira kune lymph nodes iri pedyo.
| N0 | Kwete kubatanidzwa kwemakirini emakirini emunharaunda |
| N1 | Dzimba dzenharaunda dzenharaunda dzakanaka kune kenza |
M inomirira mitastases. Kana bundu risina kupararira, rinogona kurondedzerwa se M0. Kana ikapararira kune nzvimbo dziri kure (kunze kwepancreas) inogona kutumidzwa seM1.
| M0 | Kwete yemasastasis iri kure |
| M1 | Mastastasis |
Kubva paTMM, zvipfeko zvinobva zvapa danho pakati pe 0 ne4. Panewo mamwe maitiro.
Nhanho 0: Gweta 0 inonziwo carcinoma in situ uye inoreva kenza iyo isati yapararira chimwe chinhu chinonzi chivako chepasi. Izvozvi mapfupa haasi kushaya simba (kunyange matanho anotevera anotevera) uye anofanirwa kunyatsogadziriswa.
Nhanho 1: Nhanho 1 (T1 kana T2, N0, M0) kancreatic kancreatic inowanikwa pancreas uye iri pasi pe 4 cm (inenge 2 masendimita) muhupamhi.
Chikamu chechipiri: Matanho maviri (Mat3, N0, M0 kana T1-3, N1, M0) anogona kupfuurira mberi kwepancreas (pasina kusanganisira mhepo inonzi celiac kana kuti masteric metheric yakakwirira) uye haana kupararira kune lymph nodes, kana kuti iyo pancreas asi yakapararira kune lymph nodes.
Chikamu chechitatu: Matanho matatu (T4, chero ipi zvayo N, M0) inopfuurira mberi kwepascreas uye inosanganisira chero yerariyeri kana kuti mastestamerica yemetesteric. Zvinogona kana kuti hazvina kupararira kune lymph nodes, asi hazvina kupararira kune nzvimbo dziri kure dzomuviri.
Nhanho yechina: Matanho emakumbo mana (chero T, chero ipi zvayo N, M1) inogona kuva chero zviyero. Kunyange zvazvo zvingave zvichida kana kuti hazvina kupararira kune lymph nodes, dzakapararira kune nzvimbo dziri kure zvakadai sechiropa, peritoneum (iyo micheche inowedzera mimba yemimba), mapfupa, kana mapapu.
> Sources:
> American Society of Clinical Oncology. Cancer.Net. Updated 12/2016. https://www.cancer.net/cancer-types/pancreatic-cancer/diagnosis
> Mazuva Ano uye Kuwedzera Kurapa muPancreatic Cancer, Springer Verlag, 2017.
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